Anemia occurs when your blood doesn't have enough hemoglobin. Hemoglobin is a protein in your red blood cells that carries oxygen from your lungs to the rest of your body. A common cause of anemia is not having enough iron. Children can get iron deficiency anemia when there is not enough iron in their diet to make a normal amount of hemoglobin in their blood. Growth spurts can also lead to low iron levels. Children under age 3 grow so fast that their bodies may have a hard time keeping up with the amount of iron they need.

Often, iron deficiency anemia does not cause any symptoms. However, some of the symptoms children who have iron deficiency anemia may experience include:

• Weakness and tiredness
• Pale skin
• Not feel hungry
• Dizziness
• Fast heartbeat
• Irritability
• Unusual shortness of breath during exercise
• Cold hands and feet

Iron deficiency anemia can cause your infant or toddler to have mental, motor or behavior problems. These problems can be long lasting even after treatment fixes the anemia.

Infants who drink cow's milk in the first year of life are at risk for iron deficiency anemia. Cow's milk does not have enough of the iron infants need to grow and develop, and.it is the most common dietary cause of iron deficiency in infants. Do not give cow's milk to your infant in the first year of life. Breastfed infants who do not eat iron-rich foods like iron-fortified cereal or take an iron supplement after the fourth month of life are also at risk of iron deficiency anemia. If your child is breastfed, talk to your doctor about adding some form of iron, such as iron-fortified cereal or vitamin drops with iron, to your child's diet starting at 4 to 6 months of age.

Toddlers (12 to 24 months of age) who drink a lot of cow's milk, have a diet low in iron, or already had iron deficiency as an infant are also at risk.

If you use iron-fortified formula, do not give your child vitamin drops with iron. This combination provides too much iron and is not healthy. If you decide to stop breastfeeding before your infant is 12 months of age, use iron-fortified formula. Do not use low-iron formula.

After your child is 12 months old, if you stop breastfeeding or using iron-fortified formula, you should feed your toddler meat, chicken, fish, whole grains, enriched bread and cereal, dark green vegetables, and beans. Vitamin C is also important because it helps the body absorb iron. You should limit your child to less than 24 oz of cow's milk per day. (That's 3 cups of milk.) You might try giving your child yogurt and cheese. Ask your doctor if you should continue to give your child vitamins with iron.

If you're worried and think your child might have iron deficiency anemia, talk to your doctor. Infants at risk for iron deficiency should be checked with a blood test at 9 to 12 months of age. Toddlers should be checked 6 months later and at 24 months.

Keep all products with iron stored out of the reach of your child because they can be poisonous if taken in large amounts.

1. Prevention of Iron Deficiency in Infants and Toddlers by LA Kazal, JR. (American Family Physician October 1, 2002, http://www.aafp.org/afp/20021001/1217.html )